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Gilchrist IC - AIMRADIAL 2013 - Outpatient in the US
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Gilchrist IC - AIMRADIAL 2013 - Outpatient in the US

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Same-day discharge in the US, ready for prime time?

Same-day discharge in the US, ready for prime time?

Published in: Health & Medicine, Technology

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  • <http://antiquescientifica.com/archive7.htm>copyrighted ©1982-2012 Alex PeckA G.I. severely wounded at Iwo Jima is prepared for surgery.
  • 206,489 medical inpatients in all public hospitals in the state ofVictoria, Australia, for the year 2005/2006.
  • Mitchell MD, Hong JA, Lee BY, et al. Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention. Circ Cardiovasc Qual Outcomes. 2012;5:454-462.$275 (95% CI, -$374 to -$183)a systematic review of published randomized controlled trials
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    • 1. Same-Day Discharge in the US Ready for Prime Time? Ian C Gilchrist, MD, FACC, FSCAI Professor of Medicine Pennsylvania State University Heart & Vascular Institute Hershey, PA 2nd Advanced International Masterclass AIM-RADIAL 2013
    • 2. CME Disclosure Statement AIM-RADIAL 2013 Nothing
    • 3. Hospitalization Safe? AIM-RADIAL 2013 <http://antiquescientifica.com/archive7.htm>copyrighted ©1982-2012 Alex Peck
    • 4. Hazard of Hospitalization AIM-RADIAL 2013 Model from all 206,489 pts in Victoria, Australia 2005/6 Predicted Probability of Adverse Event (%) 30 Risk of an overnight hospital stay Skin Ulcers 25 20 0.4 Infections 15 11.1 10 Adverse Drug Reactions 5 3.4 0 1 2 3 4 5 Nights in the Hospital Hauck K, Zhao X. Med Care. 2011 Dec;49(12):1068-75 6 7
    • 5. Drivers of Same Day Care AIM-RADIAL 2013 Minimize Cost Hospital Hazards Improved PCI Reimbursement Same Day PCI
    • 6. AIM-RADIAL 2013 Bleeding Ischemia Education
    • 7. Risks Same Day Discharge? AIM-RADIAL 2013 Ischemic Deaths >4 hrs post-PCI rare* • Access Site Bleeding rare TRI, low TFI • • • Education * Gibson, PROTECT-TIMI-30 Substudy, Am J Cardiol 2009;104:36-40. * Cutlip, Multicentered coronary stent trials, Circulation 2001;103:1967-1971
    • 8. Same Day v Overnight 30 Day Outcome AIM-RADIAL 2013 Odds Ratio Mantel-Haenszel Random effect, 95% CI Hospitalization MACE Complications RCT n=5 Subtotal (95% CI) Observational n=8 Subtotal (95% CI) Total (95% CI) 0.01 0.1 Same Day 1 Favors 10 100 Overnight 0.01 0.1 Same Day 1 Favors 10 100 Overnight 0.01 0.1 Same Day 1 Favors 10 100 Overnight Despite analysis of >110,000 patients, unable to resolve a difference A non-inferiority design with a sample size of > 320,000 patients needed for certainity JACC: Cardiovascular Interventions 2013; 6(2):99-112.
    • 9. AIM-RADIAL 2013 Timely Balance Mitchell MD Circ Cardiovasc Qual Outcomes. 2012;5:454-462.
    • 10. Evolution Cath Lab Procedures AIM-RADIAL 2013 2010’s Admit day of Cath/PCI & Discharge 2000’s Admit day of Cath/PCI Discharge day after PCI 1990’s Admit day of cath PCI next day 1980’s Discharge day after PCI Admit day before Dx Procedure Discharge day after cath Driven by: Technical Improvements Patient Satisfaction Efficacy Payer Demands
    • 11. “No Place Like Home” AIM-RADIAL 2013 Dorothy-Wizard of Oz After a well placed stent Thank you The Wizard of Oz. Metro-Goldwyn-Mayer, 1939